Racial Disparities in Living Donor Kidney Transplantation

Kidney transplant recipients who receive a kidney from a living donor experience significant survival benefit over recipients who undergo deceased donor kidney transplantation. There are well recognized racial disparities in access to living donor kidney transplantation, disparities that have increased over the past two decades.

Contextual poverty and socioeconomic variability are the two factors commonly thought to contribute to inequities in access to living donor kidney transplantation. However, according to A. C. Killian and colleagues, the association between living donor kidney transplantation and comprehensive measures of social vulnerability is not well established. The researchers conducted a retrospective study to assess the relationship between social vulnerability and access to living donor kidney transplant. Results of the study were reported during a virtual session at the 2021 American Transplant Congress in a presentation titled Living Donor Kidney Transplantation Racial Disparities Persist Independent of Social Vulnerability.

Using data from the Scientific Registry of Transplant Recipients, the researchers identified adult, kidney-only transplant recipients between January 1, 2018, and December 31, 2018. Census tract-level data from the Centers for Disease Control and Prevention’s 2018 Social Vulnerability Index (SVI) were linked to recipients by zip code. After controlling for patient- and community-level characteristics, the association between living donor kidney transplantation and SVI and race was assessed using logistic regression. Average adjusted predicted probabilities of living donor kidney transplantation across SVI were plotted by race.

The study included 20,380 kidney-only transplants; 30% of those were living donor transplants. There was a significant association between higher SVI (greater social vulnerability) and lower odds of living donor kidney transplant (adjusted odds ratio [aOR], 0.47; 95% confidence interval [CI], 0.40-0.57; P<.0001). Following controlling for SVI, African Americans had 57% lower odds of living donor transplant (aOR, 0.43; 95% CI, 0.39-0.48; P<.001); other races had 45% lower odds (aOR, 0.55; 95% CI, 0.48-0.63; P<.0001) of living donor kidney transplant compared with their White counterparts. At the lowest SVI, the average marginal effects for living donor kidney transplant were 13% for African Americans and 9% for other races, relative to White recipients.

In summary, the researchers said, “Greater social vulnerability is significantly associated with lower odds of living donor kidney transplant. Racial disparities in living donor kidney transplant persist independent of social vulnerability, suggesting that other factors, such as sociocultural barriers and unconscious biases require greater attention to mitigate inequities.”

Source: Killian A C, McLeod M C, Shelton B, et al. Living donor kidney transplantation racial disparities persist independent of social vulnerability. Abstract of a presentation at the virtual 2021 American Transplant Congress (Abstract #369), June 8, 2021.